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ROYAL MEDICAL AND CHIRURGICAL SOCIETY. MAY 9, 1848.—J.M. ARNOTT, ESQ., F.R.S., PRESIDENT

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582 fraquently the result of a want of power, and not uniformly, as the author would lead us to believe, of too much action. The inquiring student will doubtless look for more assist- ance in the directions for extraction than lie will find. It is stated- "Solution of a cataract is accomplished by bringing the opaque lens forward, in contact with the aqueous humour in which it is dissolved; it is subsequently absorbed."-p. 202. If by this it is intended to dislocate the lens, and bring it into the anterior chamber, we must say that we dissent from such advice; for the most destructive inflammation often ensues, when the lens is placed in that situation, and the judi- cious operator always endeavours to avoid such an occurrence. The author’s success must have been very great in needle operations, when he tells us that inflammation threatening the safety of the organ hardly ever follows."-p. 206. We here close the notice of this work, and although some of the subjects are but insufficiently dwelt upon by the author, we are glad to say that the editor has made up for the omis- sions, in a great part, by his able notes, and we cannot do otherwise than recommend the book, which is well got up, and embellished with numerous highly-coloured and descriptive plate On the .1Yature and Treatment of Renal Diseases, &-c. By WIL- LIAM PROUT, M.D., F.R.S., F.R.C. Phys. Lond. Fifth Edi- tion, Revised. London: Churchill. 1848. 8vo. pp. 595. With coloured and other Engravings. THE repeated editions of a standard work usually demand little notice at the hands of the reviewer: the claims of the produc- tion to public attention are so far established by the time it has reached so many impressions as the work before us, as to render comment unnecessary, unless alterations are introduced. In this present edition, Dr. Prout has placed last, instead of first, the controversial section, which contained most of his Qbjections to the modern views on organic chemistry, making that a third book which was heretofore an introduction. This fact has some significance, which is still more apparent if we compare the terms in which the prefaces to the two last editions are couched. In that to the fourth edition, Dr. Prout says,- " Since the third edition was published, Professor Liebig’s treatises on Vegetable and Animal Chemistry have made their appearance, and attracted no little notice. Some of the views advanced by this distinguished chemist in his last work, are the same I have long advocated. Others of his views are directly opposed to mine, and seem to me to be neither suscep- tible of proof, nor even probable..... I have purposely omitted the formulae now so much in fashion among chemists, not only because I consider them clumsy and unphilosophical as conventional expedients, but because I am satisfied that very few, if any of them, represent the true constitution of organized substances.’-pp. vii. viii. In that to the fifth he only remarks,! " I have still omitted the chemical formulæ now in fashion, because in general I do not deem them trustworthy. In a great many instances, before the truth can be known, chemists must work more, and speculate less. " Some late investigations have indeed been of a better cha- racter ; and physiology and pathology will yet, I trust, derive those elucidations from chemistry, which this science, legiti- mately applied, alone can give:"—p. ix. The former italics are our own; the latter those of the author. Dr. Prout’s opposition to the deductions of the Liebig school appears becoming " fine by degrees, and beau- tifully less," and we draw attention to the above extracts, which, amongst other circumstances, lead us to form this opinion. SURGERY IN SpAIN.—Dr. Olivares, Dean of the University of Santiago, (Spain,) has recently performed the disarticulation of the thigh bone, and this perilous operation has been fol- lowed by complete success, (we are not informed in what particular.) The talent of this professor has contributed to shed a certain lustre on the university over which he presides. Medical Societies. ROYAL MEDICAL AND CHIRURGICAL SOCIETY. MAY 9, 1848.—J.M. ARNOTT, ESQ., F.R.S., PRESIDENT. I EXTRAORDINARY CASE OF BILIARY CONCRETIONS. By EDWARD WILLSON DUFFIN, M.R.C.S. t The patient, a man, sixty-five years of age, had, on several r occasions during the last three years, consulted the author for symptoms that were presumed to proceed from deep-seated, sub-acute inflammation of the liver. He was also subject to - dyspepsia. On the night of the 25th of January last, he was . seized with vomiting and hiccup, which continued, with only j trifling intermissions, for three days. On the third day he . vomited about three pints of a fluid like coffee-grounds. Uneasi- ness in the abdomen, a little to the left of the umbilicus, had annoyed him occasionally for some time, and there was now tenderness in the same situation. There was no jaundice, but , he gradually became much emaciated, and at length, without new symptoms, died on the 9th of March. On examination after death, two folds of intestine, to the left of the umbilicus, were found adherent to each other by recently effused lymph, and in an angular pouchlike dilatation of this portion of intestine, (the jejunum,) a large wedge-shaped concretion was found. The gall-bladder, in its entire length, on its under surface, was found to have been destroyed by ulceration, the edges of the remaining portion being continuous with the edges of a large perforating ulcer in the anterior walls of the duodenum. The duodenum presented two pouches, of one of * which the anterior part of the gall-bladder formed the apex. Lodged in these pouches were three large biliary concretions. The length of the four concretions, all of which had bevelled surfaces, was, when they were fitted together, six inches and a half. Their weight was two ounces, five drachms, nineteen grains. The author referred to two similar cases, one related by Cruveilhier, the other by Mr. Blagden, of Petworth, in the Medico-Chirurgical Transactions, vol. iv. In neither of these cases was the mass of concretions so large as in the present instance. - -- - ....... in answer to a question, Mr. IJUFFIN saia that tne compo- sition of the calculi was pure bile. Dr. WILLIAMS related the case of a gentleman who suffered from all the symptoms of the passage of gall stones, distinctly marked, not only by pain and jaundice, and obstructed flow of the bile, but also by a tumour corresponding to the position of the gall bladder. This tumour presented itself before each attack; on percussion around it, a tympanitic sound was de- tected. The patient’s health declined. He was of sedentary habits, and the attacks became so frequent, that they occurred every ten or fourteen days. No medicine or diet that he was placed under seemed to be of any particular service to him, and his friends and attendants began to suspect, notwithstand- ing the clearness of the signs, that his complaint was not in reality found out. The faeces, on being examined, were found contain concretions, consisting of cholesterine. What, then, could be administered to prevent the formation of these fatty concretions. It was determined to try the effect of the cod- liver oil. After a very short time, the bile was found to be better secreted, both in regard to its quality and quantity. No attack of gall-stones occurred until the end of three weeks. On examining the abdomen, the same lump was found as be- fore, but two inches lower down in the abdomen; and the liver, which before could not be felt at all, was now to be detected by the touch, two inches below the margin of the rib; it was evidently enlarged, but neither painful nor tender. This attack went off under the use of the usual remedies, and in a few days the cod-liver oil was resumed, and up to the present moment,-a, period of two months,-there had been no return of his attack. His digestion was better, and his health much improved. This was a solitary case; but it was interesting taken in connexion with the increase of the size of the liver, and with the improvement of the patient’s health. It showed that the cod-liver oil, in opposition to remedies of this class generally, promoted the proper action of the liver, and con- sequently the secretion of bile. CONTRIBUTIONS TO THE STATISTICS OF VALVULAR DISEASE OF THE HEART, ESPECIALLY WITH REFERENCE TO AFFECTIONS OF THE SEVERAL ORIFICES, AND THE PARTICULAR EFFECTS OF CERTAIN RECOGNISED CAUSES. By A. WHYTE BARCLAY, M.D. The facts which form the basis of this paper have been collected chiefly from the 3luseum Records of St. George’s
Transcript
Page 1: ROYAL MEDICAL AND CHIRURGICAL SOCIETY. MAY 9, 1848.—J.M. ARNOTT, ESQ., F.R.S., PRESIDENT

582

fraquently the result of a want of power, and not uniformly, asthe author would lead us to believe, of too much action.The inquiring student will doubtless look for more assist-

ance in the directions for extraction than lie will find. It is

stated-"Solution of a cataract is accomplished by bringing the

opaque lens forward, in contact with the aqueous humour inwhich it is dissolved; it is subsequently absorbed."-p. 202.

If by this it is intended to dislocate the lens, and bring itinto the anterior chamber, we must say that we dissent fromsuch advice; for the most destructive inflammation often

ensues, when the lens is placed in that situation, and the judi-cious operator always endeavours to avoid such an occurrence.The author’s success must have been very great in needle

operations, when he tells us that inflammation threateningthe safety of the organ hardly ever follows."-p. 206.We here close the notice of this work, and although some

of the subjects are but insufficiently dwelt upon by the author,we are glad to say that the editor has made up for the omis-sions, in a great part, by his able notes, and we cannot dootherwise than recommend the book, which is well got up, andembellished with numerous highly-coloured and descriptive

plate

On the .1Yature and Treatment of Renal Diseases, &-c. By WIL-LIAM PROUT, M.D., F.R.S., F.R.C. Phys. Lond. Fifth Edi-tion, Revised. London: Churchill. 1848. 8vo. pp. 595.With coloured and other Engravings.

THE repeated editions of a standard work usually demand littlenotice at the hands of the reviewer: the claims of the produc-tion to public attention are so far established by the time ithas reached so many impressions as the work before us, as torender comment unnecessary, unless alterations are introduced.In this present edition, Dr. Prout has placed last, insteadof first, the controversial section, which contained most of hisQbjections to the modern views on organic chemistry, makingthat a third book which was heretofore an introduction. Thisfact has some significance, which is still more apparent if wecompare the terms in which the prefaces to the two lasteditions are couched. In that to the fourth edition, Dr. Proutsays,-

" Since the third edition was published, Professor Liebig’streatises on Vegetable and Animal Chemistry have made theirappearance, and attracted no little notice. Some of the viewsadvanced by this distinguished chemist in his last work, arethe same I have long advocated. Others of his views aredirectly opposed to mine, and seem to me to be neither suscep-tible of proof, nor even probable..... I have purposelyomitted the formulae now so much in fashion among chemists,not only because I consider them clumsy and unphilosophicalas conventional expedients, but because I am satisfied thatvery few, if any of them, represent the true constitution of organized substances.’-pp. vii. viii. In that to the fifth he only remarks,!" I have still omitted the chemical formulæ now in fashion,

because in general I do not deem them trustworthy. In agreat many instances, before the truth can be known, chemistsmust work more, and speculate less." Some late investigations have indeed been of a better cha-

racter ; and physiology and pathology will yet, I trust, derivethose elucidations from chemistry, which this science, legiti-mately applied, alone can give:"—p. ix.The former italics are our own; the latter those of the

author. Dr. Prout’s opposition to the deductions of theLiebig school appears becoming " fine by degrees, and beau-tifully less," and we draw attention to the above extracts,which, amongst other circumstances, lead us to form this

opinion.

SURGERY IN SpAIN.—Dr. Olivares, Dean of the University ofSantiago, (Spain,) has recently performed the disarticulationof the thigh bone, and this perilous operation has been fol-lowed by complete success, (we are not informed in whatparticular.) The talent of this professor has contributed toshed a certain lustre on the university over which he presides.

Medical Societies.

ROYAL MEDICAL AND CHIRURGICAL SOCIETY.

MAY 9, 1848.—J.M. ARNOTT, ESQ., F.R.S., PRESIDENT.

I EXTRAORDINARY CASE OF BILIARY CONCRETIONS. By EDWARDWILLSON DUFFIN, M.R.C.S.

t The patient, a man, sixty-five years of age, had, on severalr

occasions during the last three years, consulted the author forsymptoms that were presumed to proceed from deep-seated,sub-acute inflammation of the liver. He was also subject to

- dyspepsia. On the night of the 25th of January last, he was. seized with vomiting and hiccup, which continued, with onlyj trifling intermissions, for three days. On the third day he. vomited about three pints of a fluid like coffee-grounds. Uneasi-’

ness in the abdomen, a little to the left of the umbilicus, hadannoyed him occasionally for some time, and there was nowtenderness in the same situation. There was no jaundice, but

, he gradually became much emaciated, and at length, withoutnew symptoms, died on the 9th of March. On examinationafter death, two folds of intestine, to the left of the umbilicus,were found adherent to each other by recently effused lymph,and in an angular pouchlike dilatation of this portion ofintestine, (the jejunum,) a large wedge-shaped concretion wasfound. The gall-bladder, in its entire length, on its undersurface, was found to have been destroyed by ulceration, theedges of the remaining portion being continuous with theedges of a large perforating ulcer in the anterior walls of theduodenum. The duodenum presented two pouches, of one of

*

which the anterior part of the gall-bladder formed the apex.Lodged in these pouches were three large biliary concretions.The length of the four concretions, all of which had bevelledsurfaces, was, when they were fitted together, six inches anda half. Their weight was two ounces, five drachms, nineteengrains. The author referred to two similar cases, one relatedby Cruveilhier, the other by Mr. Blagden, of Petworth, inthe Medico-Chirurgical Transactions, vol. iv. In neither ofthese cases was the mass of concretions so large as in thepresent instance.

- -- - .......

in answer to a question, Mr. IJUFFIN saia that tne compo-sition of the calculi was pure bile.

Dr. WILLIAMS related the case of a gentleman who sufferedfrom all the symptoms of the passage of gall stones, distinctlymarked, not only by pain and jaundice, and obstructed flow ofthe bile, but also by a tumour corresponding to the position ofthe gall bladder. This tumour presented itself before eachattack; on percussion around it, a tympanitic sound was de-tected. The patient’s health declined. He was of sedentaryhabits, and the attacks became so frequent, that they occurredevery ten or fourteen days. No medicine or diet that he wasplaced under seemed to be of any particular service to him,and his friends and attendants began to suspect, notwithstand-ing the clearness of the signs, that his complaint was not inreality found out. The faeces, on being examined, were found

contain concretions, consisting of cholesterine. What, then,could be administered to prevent the formation of these fattyconcretions. It was determined to try the effect of the cod-liver oil. After a very short time, the bile was found to bebetter secreted, both in regard to its quality and quantity.No attack of gall-stones occurred until the end of three weeks.On examining the abdomen, the same lump was found as be-fore, but two inches lower down in the abdomen; and the liver,which before could not be felt at all, was now to be detectedby the touch, two inches below the margin of the rib; it wasevidently enlarged, but neither painful nor tender. Thisattack went off under the use of the usual remedies, and in afew days the cod-liver oil was resumed, and up to the presentmoment,-a, period of two months,-there had been no returnof his attack. His digestion was better, and his health muchimproved. This was a solitary case; but it was interestingtaken in connexion with the increase of the size of the liver,and with the improvement of the patient’s health. It showedthat the cod-liver oil, in opposition to remedies of this classgenerally, promoted the proper action of the liver, and con-sequently the secretion of bile.

CONTRIBUTIONS TO THE STATISTICS OF VALVULAR DISEASE OF THEHEART, ESPECIALLY WITH REFERENCE TO AFFECTIONS OF THESEVERAL ORIFICES, AND THE PARTICULAR EFFECTS OF CERTAINRECOGNISED CAUSES. By A. WHYTE BARCLAY, M.D.The facts which form the basis of this paper have been

collected chiefly from the 3luseum Records of St. George’s

Page 2: ROYAL MEDICAL AND CHIRURGICAL SOCIETY. MAY 9, 1848.—J.M. ARNOTT, ESQ., F.R.S., PRESIDENT

583

Hospital,. The author has confined his attention to the caseswhich have occurred within the last two years. During thatperiod there have been 535 deaths in the hospital, and in therecords of the post-mortem examinations in 419 of these cases,the condition of the circulating organs has been stated. In

seventy-nine cases valvular lesion was found.In an elaborate statistical table the author exhibits the fol-

lowing facts with regard to each of these seventy-nine cases.The condition of the valves, aortic and mitral; the age and sexof the patient; the existence or absence of atheroma in theaorta; the previous existence or not of acute rheumatism; thestate of the heart as to size, thickness of walls, &c.; the stateof the pleura and pericardium, as to recent inflammation orold adhesions; the state of the kidneys; other disease foundin the body; and the chief cause of death. The author insti-tutes a minute comparison of the seventy-nine cases, and ofthe remainder of the 419 cases, with reference to these points;and remarks, in conclusion, that some of the deductions seemto him "worthy of attention, and demanding at least furtherinvestigation. The liability to double valvular disease (ratherthan disease of either the mitral or aortic valve separately)in consequence of rheumatic endocarditis, and the early in-cursion as well as the commonly early termination of thatdisease,-the limit put by age in so marked a manner tofibrinous deposit on the valves of the heart,-the very largeproportion, amounting to almost one-half, of the fatal cases ofgranular kidney found coincident ’with valvular disease, andits comparative rarity in those cases in which the kidney islarge and mottled, are all facts clearly established with re-gard to these cases. To others must be left to determinewhether they hold good in their more general application." One commonly received opinion these cases contradict-

viz., that atheromatous disease affects by preference the mitralvalve; and another is at least doubtful-viz., that it is in theadvanced stage of Bright’s disease that endocarditis is liableto occur, unless we admit a form of endocardial inflammationwithout fibrinous deposit." "Dr. WILLIAMS, after showing the admissibility of heart dis-

eases being tested as to frequency and fatality by statistics,thought the numbers in Dr. B Brclay’s communication scarcelysufficient to draw the several conclusions to which he hadarrived. With several of these conclusions, however, his(Dr. Williams’s) own experience agreed. There was a differ-ence, however, in one, and that was with respect to the termi-nation of valvular disease from rheumatism. The author ofthe paper had stated that valvular disease from this cause ter-minated fatally early. This was opposed to his (Dr.Williams’s)experience on this point, for he had found disease of thesevalves less speedily fatal from rheumatism than when it de-pended on other causes; and the prognosis was more favour-able. He had seen cases of valvular disease in persons ofadvanced age, in whom the disease had developed itself, afterone or more attacks of acute rheumatism in early life.

ON THE ANATOMY AND PHYSIOLOGY OF THE CYSTICERCUS TEN-NICOLLIS. By C. B. ROSE, F.R.C.S., F.G.S.

The object of the author is, to afford a more accurate andcorrect account of the anatomy and physiology of the cysti-cercus tennicollis than has hitherto been given by previouszootomists. He commences with an historical notice of the re-searches of other naturalists into the structure and functionsof this parasite, from the time of Bartholin to the presentperiod, and then proceeds to recount the result of his own in-vestigations and dissections. He has found it chiefly infestingthe serous cavities of the ruminantia, and invariably occupy-ing a cyst. The vesicular body, its external and internal coat,its proboscis with its circlet of hooks, are severally described.With respect to the last-mentioned appendages, the authorconsiders them to be endowed with muscular power, and toact by mechanically irritating or scratching the interior of thecontaining cyst, to excite the secretion of a pabulum for thesustenance of its tenant. The structure and physiology ofthe internal organs are next discussed; and the author con-siders that the animal is nourished by endosmosis, the granularpa,rticles of the albumen secreted being excluded. As regardsthe propagation of this parasite, he has been able (in commonwith other zootomists) to satisfy himself of that mode alonewhich is termed gemmation. But as the gemmae are deve-loped within the parent, this process cannot account for theirdissemination; the author therefore conjectures that the pro-pagation of the cysticercus may be by ova as well as gemmae.He concludes his paper with a few observations on themorbid changes to which this vesicular entozoon is not un-frequently subject.

MEDICAL SOCIETY OF LONDON.

MONDAY, MARCH 27, 1848.—MR. HANCOCK, PRESIDENT.

ENTERO-COLITIS.

DB.’WiLLSHiRE exhibited the larger intestine of a hoy agedone year and three months. He remarked that he had severaltimes taken an opportunity of exhibiting to the Society spe-cimens illustrative of one very common and fatal disease-viz., the so-called acute hydrocephalus-and which, he be-lieved, tended to substantiate the opinion, that the disorderin question is properly termed tuberculous meningitis. Henow laid before the Society intestinal lesions illustrative ofone other very common and unmanageable disorder of infancy-viz., entero-colitis. This was a disorder which Dr. Will-shire believed to be very often mistaken for other afiectionsof young children, and fatal cases, as well as others, werefrequently denominated mesenteric disorder, infantile ma-rasmus, cachexia, remittent fever, &c. Entero-colitis carriedoff a great number, especially among the poor; and this par-ticular form of disease in question was almost confined tochildren below two years of age. Diarrhoea, and its conse-quent marasmus, were its more prominent symptoms duringlife, and hypertrophy and ulceration of the follicles, with in-flammation of the colon, rectum, and ilio-cspcal portion of thebowels, its more marked anatomical characters seen afterdeath. The child from whom the specimens before theSociety were procured had had diarrhoea off and on for nearlythree months, and eventually died exhausted, and with symp-toms of hydrocephaloid disorder. No tubercles were foundin the lungs, spleen, or mesenteric glands. The brain wasrather softer than usual, and there was slight, transparenteffusion on the hemispheres and at the base, but no signs oftubercular disease of the membranes.

Dr. CoLEY agreed with Dr. Willshire as to this diseasebeing frequently mistaken for mesenteric disease. It gene-rally began with dysentery, from exposure to cold or errorsin diet, and was accompanied with remittent fever; whilst inmesenteric disease the attacks come on periodically with dis-charge from the bowels. The best plan of treatment he hadfound to be the use of gentle aperients, rhubarb and magnesia.When ulceration had taken place, he had found alum andopium very useful, even in a case dismissed from a hospitalas incurable.The PRESIDENT inquired if Dr. Willshire had tried turpentine

in these cases ? ’1Dr. WILLSHIRE had not tried it, as he never gave it except

when there was a tympanitic affection. The treatment hehad employed comprised, emollient cataplasms to the abdomen,warm baths, chalk mixture, &c., milk, and isinglass: nitrateof silver he had found the best remedy in the earlier stages.We must stop the exhausting discharge before we couldsubdue the inflammation ; bleeding and leeches were of littleuse. Castor oil and neutral salts he now and then used, andhe had found the sesquicarbonate of soda, and hydrocyanicacid, in caraway water, remain on the stomach when otherremedies would not. The nitrate of silver acted as a tonic,as well as in stopping the discharges, the child improving inflesh under its use. The inflammation often existed only onthe folds of the intestines, and appeared to be caused by theT)f).ss:is of the discharges.Mr. SHEARLEY said he had seen nitric acid, combined with

syrup and tincture of cardamoms, very successful in cases ofcatarrh of the mucous membrane of the intestines.The PRESIDENT thought that bad air and locality were the

chief causes of the affection. Some years ago he was sent to

Nottingham, to inquire into the cause of the mortality of thechildren in the workhouse: out of 108 children, eight or tendied in the twenty-four hours. The symptoms were similarto those in Dr.Willsliire’s cases: there were, enlarged abdomen,enlarged papillae, hectic flush, no appetite, diarrhoea. Medicaltreatment was of no use-the disorder depended upon badair. Fifty or sixty children were crowded into a small room,(allowing only half a cubic yard to each individual;) it wassurrounded by sick wards; the air was so bad that the windowswere obliged to be opened for some time before the medicalman could enter. He recommended the children to be re-moved from the workhouse, and distributed about the neigh.bourhood, and the complaint was stopped at once. The samething happened at Sevenoaks and at Marylebone, from thecrowded state of the beds.

Dr. CoLEy said that there was a marked connexion betweenthe state of the atmosphere and the condition of the liningmembrane of the intestinal canal: there was no doubt that thedysentery at the Penitentiary, terminating in ulceration of


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